Nurses Pushing Propofol for Conscious Sedation -Your Thoughts? - page 5

I would be interested in getting feedback from GI nurses that are involved in propofol sedation in settings with and without anesthesia. Your thoughts and experiences please. Thank you, Randy... Read More

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    Quote from foraneman
    Regarding sedation of ER, ICU and rapid response patients....I would be interested in hearing how many are intubated, or are sedated with the goal of intubating, versus just sedated. Full stomachs sedated with propofol? Since all these patients WOULD be full stomachs....
    *** None are sedated with a GOAL of intubating. They are not all full stomachs either. I don't know why you would think / say that. We usually keep them NPO prior to cardioversions, EGDs and other planned procedures.
    I have to do 30 supervised intubations each year to maintain my competency but I am only part time. Full time people have to do fewer. All of us also do or used to do transport, either ground or flight or both.
    Propofol and propofol / fentanyl sedation has been working very well in our faciliety. I don't think anyone would want to go back to versed & fentanyl only.
    They do not use propofol in our GI lab unless either the rapid response nurse does it (happens occasionaly at NOC but unusual) or a CRNA (more common during the day). The GI nurses still use versed / fentanyl.
    I should add that now, after 4 years of using propofol for sedation there is talk of expanding it's use to the GI lab by BI nurses but has not happend yet. Also we have a CRNA a phone call way with a resonse time from their call room of (usally) much less than 5 min.
    Last edit by PMFB-RN on May 19, '11

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  2. 0
    Foranmen I agree it is not outrageous or unusual for patients to request x,y,z for procedures, but if that clinic is only used to doing it x way that is when you know there is going to be a problem. Where an anesthesia provider could use just about any of these medications alone or in combination and have positive outcomes normal RNs and endoscopists aren't going to have that training to do that and the outcome is more than likely going to be less than satisfactory. It should have been a red flag right away for any health professional no matter what their speciality when a clinic goes out of their way to try push doing a procedure only one way. That is the time to either agree, come to some middle ground or just walk away. I personally don't want to be the guinea pig while they try to figure out how to dose a medication based on what is in their nursing drug manual.

    The problem with NAPs is that all the studies done with 300k+ patients has shown NAPs to be safe and effective. As a professional organization (the AANA or ASA) has not found any research/evidence that shows NAPs to be unsafe. This to me is me is very biased since our whole argument as a profession is that CRNAs are just as safe and effective as anesthesiologists is based EBP.

    I realize as a CRNA that is not popular statement to make, but if we are going to try to deny other professional organizations from using propofol then we need to come up with some kind of research that proves our point other than just our belief that is unsafe for RNs to administer propofol sedation.
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    Quote from foraneman
    I HAVE seen the 1 in 500...or 1000....or whatever u want to claim...that after a 'little' propofol turns blue, vomits bile and has a laryngospasm while the non-anesthesia provider freaks out pushing the big button on the wall.

    Since propofol has no analgesic properties you either dose to a near plane of general anesthesia to avoid any pain recall or you add an analgesic. The fact that the OP did not have ANY effect from the 'fentanyl' here is rather concerning. If one adds the inappropriate behavior of the RN to the mix you have to wonder about the possibility of diversion for self administration.
    Yes, I am sure patients have had bad outcomes with NAPs (not from these carefully controlled studies that are out there, but I am sure it happens), but because of its unique properties propofol has been shown to have less adverse reactions in NAPs than using traditional combinations (Versed, Fentanyl and/or Demerol).

    I think this is one side to the story only, but in my opinion the clinic did not do their job in properly communicating with the patient. 75mcg of Fentanyl is nothing to a lot of patients especially when you don't know what other medications they are on, if they are a fast metabolizer, red headed etc, and especially when it is used as the sole medication. Then you add on top of that the patient is already extremely anxious dealing with a clinic that has seemingly done little to nothing to ease the patient's anxiety I don't see that 75mcg is an unreasonable dose. I would actually consider 75mcg a little on the low side depending on how fast the procedure went. I would never think to suggest that someone is diverting the drug especially from a clinic that probably doesn't use fentanyl much in the first place if they went to so much trouble trying to convince the patient to use propofol sedation instead.
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    “it is also interesting to note that many countries do not routinely do sedation/analgesia at all for colonoscopies, because it isn't considered that painful. a lot of what we perceive is based on cultural perception”.

    foraneman, what do you think of that (wtbcrna’s) response related to the experience of pain reported?:”... the pain could make you tighten up, causing the colon to contract and exacerbate the pain. since i have ibs, it’s possible that my colon was already in spasm [thus contributing to the pain]”.


    as you put it, “since propofol has no analgesic properties you either dose to a near plane of general anesthesia to avoid any pain recall or you add an analgesic”, this was a concern i expressed but the doc essentially denied this to be true.

    ps. before he “agreed” to my request for fentanyl and to my refusal of propofol, he insisted dismissively, “you’ll just have to trust me”.
    Last edit by health professinal on May 19, '11 : Reason: clear up potential confusion about who I was referring to
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    The way of perceiving, expressing, and controlling pain is one of these learned behaviors that, when manifested, is culture-specific (2). Moreover, cross-cultural data gathered by anthropologists during their fieldwork—the anthropological term for research—show that, while few universals exist between and among discrete societies, from the small, undeveloped, primitive ones to the large, developed, industrialized ones, pain is one of these universals. Thus, while the stimulation of pain fibers to tell the brain that something is wrong is the same among all human beings, the perceptions and control of pain vary from society to society.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1276504/

    Cultural pain perception is well known and studied phenomenon.
  6. 0
    i directed this question to foraneman. i am already aware of the issue of "cultural pain perception". i have a high pain threshold. i am interested in foraneman's and others' opinions specifically re the possibility that ibs spasms might cause pain during a colonoscopy.
  7. 1
    Quote from health professinal
    i directed this question to foraneman. i am already aware of the issue of "cultural pain perception". i have a high pain threshold. i am interested in foraneman's and others' opinions specifically re the possibility that ibs spasms might cause pain during a colonoscopy.
    public forum so your stuck with me.......especially when you use one of my posts and make a comment on it.
    Horseshoe likes this.
  8. 0
    http://www.nature.com/ajg/journal/v1...g2009429a.html

    Decreased pain with colonoscopies with warm water intake especially for patients with IBS.
  9. 0
    Quote from wtbcrna
    http://www.nature.com/ajg/journal/v1...g2009429a.html

    Decreased pain with colonoscopies with warm water intake especially for patients with IBS.
    Thank you.
  10. 0
    originally posted by wtbcrna
    http://www.nature.com/ajg/journal/v1...g2009429a.html

    decreased pain with colonoscopies with warm water intake especially for patients with ibs.
    thank you.

    actually a very enthusiastic thank you for referring me to that site! i found some other great research articles. i can see that you genuinely like to share information that might be of help to others- although i hope you won't be offended if i say that your "bedside manner" might not work so well in my field


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